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Classification and Management of Metopic Craniosynostosis

Yee, Sydney T. BSc*; Fearon, Jeffrey A. MD; Gosain, Arun K. MD; Timbang, Mary R. BA*; Papay, Frank A. MD§; Doumit, Gaby MD, MSc§

doi: 10.1097/SCS.0000000000001866
Original Articles

Background: In the craniofacial surgery literature, there is a wide disparity of opinions regarding the management of nonsyndromic metopic synostosis. With the lack of level I evidence to support a particular regimen, we aimed to elucidate the current state of practice among craniofacial surgeons with the hope of establishing a standard of care.

Methods: A survey was sent to 102 craniofacial surgeons. The survey featured 2 parts: clinical scenarios and questions regarding the following: primary indication for surgery, preference of timing, and choice of operative intervention for patients presenting with nonsyndromic isolated metopic synostosis. Surgeons were also queried regarding preoperative, intraoperative, and postoperative protocols.

Results: The total response rate was 72% (73/102) for the clinical scenarios and 63% (64/102) for the complete survey. There was a large discrepancy when classifying and managing mild metopic synostosis, with between 16% and 35% of surgeons electing to operate on a mild case. All surgeons agreed to operate on moderate and severe cases. For 95% of respondents, skull deformity was the primary indication for treatment of craniosynostosis. Open surgical management was most commonly performed at 6 months (29%) of age. Open frontal orbital advancement was the most commonly performed procedure in mild (27%), moderate (77%), and severe (89%) cases. Endoscopic approaches were more likely to be used in milder cases by 19% of surgeons.

Conclusion: Our survey demonstrates that there is a wide disparity of opinion among craniofacial surgeons regarding the diagnosis and management of mild nonsyndromic metopic synostosis.

Level of Evidence: Diagnostic, level 5.

*School of Medicine, Case Western Reserve University, Cleveland, OH

The Craniofacial Center, Dallas, TX

Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL

§Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH.

Address correspondence and reprint requests to Gaby Doumit, MD, MSc, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; E-mail:

Received 9 November, 2014

Accepted 29 March, 2015

This project was supported by institutional funds.

The authors report no conflicts of interest.

© 2015 by Mutaz B. Habal, MD.